GCU Implementation of Watson’s Theory of Human Caring Case Study Discussion

Week 5: Assignment – Critical Appraisal of Jean Watson’s Theory of Human Caring

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Jean Watson’s Theory of Human Caring is a conceptual thread in the USU College of Nursing’s curriculum framework. The purpose of this assignment is to offer students the opportunity to be exposed to Human Caring Science while providing students with the skills of critical appraisal of evidence.

  • Students will select one nursing research article that focuses on a study that used Jean Watson’s Theory of Human Caring as a theoretical framework.
  • Students should use as a guide, an appropriate Rapid Critical Appraisal Checklist found in Melnyk & Fineout-Overholt (2019; pp. 708-722).
  • The critiques are to be informal, although correct grammar, spelling, etc., are expected. The critique should include a brief description of the study that was reviewed and should address elements of the study relevant to critique.
  • Students will provide a written critique on a critical appraisal of the elements relevant to the nature of the research study such as type of study, design, quality of the study; and rationale, as well as implications for practice and further research and/or evaluation.
  • Rapid Critical Appraisal Checklist for a Randomized Clinical Trial (RCT)
    1. Are the study findings valid?
    a. Were the subjects randomly assigned to the
    experimental and control groups?
    b. Was random assignment concealed from the
    individuals who were first enrolling subjects into
    the study?
    c. Were the subjects and providers blind to the
    study group?
    d. Were reasons given to explain why subjects did not
    complete the study?
    e. Were the follow-up assessments conducted long
    enough to fully study the effects of the intervention?
    f. Were the subjects analyzed in the group to which
    they were randomly assigned?
    g. Was the control group appropriate?
    h. Were the instruments used to measure the
    outcomes valid and reliable?
    i. Were the subjects in each of the groups similar
    on demographic and baseline clinical variables?
    2. What are the results of the study and are they important?
    a. How large is the intervention or treatment effect
    (NNT, NNH, Effect size, level of significance)?
    b. How precise is the intervention or treatment (CI)?
    3. Will the results help me in caring for my patients?
    a. Were all clinically important outcomes measured?
    b. What are the risks and benefits of the treatment?
    c. Is the treatment feasible in my clinical setting?
    d. What are my patients/family’s values and expectations
    for the outcome that is trying to be prevented and
    the treatment itself?
    Modified from Melnyk, B. (2004). Rapid Critical Appraisal of Randomized Controlled Trials (RCTs): An
    Essential Skill for Evidence-Based Practice, Melnyk, Pediatric Nursing Journal.
    © Fineout-Overholt & Melnyk, 2005. This form may be used for educational, practice change & research purposes
    without permission.
    International Journal of Caring Sciences
    January-April 2015 Volume 8 Issue 1
    Page 25
    Implementation of Watson’s Theory of Human Caring: A Case Study
    Yeter Durgun Ozan, PhD, BSN
    Assistant professor, School of Nursing, University of Dicle, Diyarbakır, Turkey
    Hülya Okumuş, Ph.D
    Professor, Şifa Üniversit, Faculty of Health Sciences, Izmir, Turkey
    Ayhan Aytekin Lash, PhD, RN, FAAN
    Professor Emeritus, School of Nursing and Health Studies, Northern Illinois University
    DeKalb, Illinois, USA
    Correspondence: Ayhan Aytekin Lash, Professor Emeritus, School of Nursing and Health Studies, Northern
    Illinois University DeKalb, Illinois, USA E-mail: ayhanalash@gmail.com
    This manuscript presents a case study detailing the application, and the outcome, of the Watson’s Theory of
    Human Caring to an infertile woman receiving in vitro fertilization treatment. The implementations of the ten
    carative factors, inherent in the theory, to provide a supportive nursing care are chronicled. The sustained nursepatient interaction and the achievement of the ultimate goal of having the patient reach the phase of “healthhealing-wellness” (carative factor #7) were detailed. This case study is an example of the value of a theory-based
    nursing practice that can enhance human health and healing in stressful life events, such as “the moment” when
    the patient in this case study realized her inability to have conceived a much desired child, even with promising
    medical treatments, and turned to her nurse for healing.
    Keywords: Infertility, unsuccessful IVF treatment, Watson’s theory of human caring
    Infertility is not only a physiological problem but
    it is one that can initiate a life crisis that is
    experienced with psychological, familial, social,
    and cultural consequences (Devine, 2003).
    Hence, increasingly, infertile couples look for a
    recovery from this life crisis and often turn to invitro-fertilization (IVF) for solutions. In the
    beginning of the treatment, couples are hopeful
    that a pregnancy will occur (Boden, 2007).
    However, success is not a given, repeated
    treatments may be needed before fertilization is
    Given the recurrent need for
    retreatment, from the very beginning it is
    important that health care professional assess
    how the women may adjust to unsuccessful
    outcomes. In fact, this early assessment may be
    the key to prepare them to cope with feelings of
    failure, loss, hopelessness, and regain the
    emotional health to initiate retreatment. This
    early assessment is also necessary because
    evidence suggests that women cannot become
    pregnant if they are under emotional distress
    during the treatments (Durgun-Ozan & Okumuş,
    2013; Benyamini, Gozlan & Kokia, 2005; Widge
    2005; Verhaak et al, 2005; Franco et al, 2002;
    Hammarberg, 2001). Further, Fawcett (2005) and
    others (Chin, 2001; Fawcett et al, 2001), indicate
    that when unsuccessful IVF treatment occurs,
    giving nursing care based on nursing-specific
    theories that provide holistic nursing care,
    including individual assessment, observation, and
    a keen focus on problems unique to each woman,
    may be essential. In terms of clinical application
    of these studies, it is evident that the women
    undergoing fertility treatments need constant
    monitoring of emotional health in tandem with
    theory-based emotional support, and a nursing
    approach that is based on close, individualized,
    when possible, face-to-face contact (DurgunOzan & Okumuş, 2013). A recent (2014)
    randomized study reported that nursing care
    based on Watson’s theory of Human Caring
    International Journal of Caring Sciences
    January-April 2015 Volume 8 Issue 1
    decreased the negative impact of infertility in
    women receiving infertility treatment (ArslanÖzkan, Okumuş & Buldukoğlu, 2014).
    Therefore, the goal in this particular nursing case
    study was to prepare an infertile woman to accept
    an outcome of an initially unsuccessful treatment
    and, at an appropriate time, support the woman in
    her decision to try re-treatment. In order to reach
    this goal, however, it was explore and delineate
    the kind of nursing interventions that would be
    effective in helping the infertile woman cope
    with her negative feelings about self, and thereby,
    improve her sense of well-being (Payne &
    Goedeke, 2007). Hence, this case was undertaken
    to assess and evaluate the implementation of the
    Watson’s theory of Human Caring to the care of
    a woman who has had unsuccessful IVF
    treatment at first attempt.
    Watson’s Theory of Human Caring
    The theory of Watson’s Human Caring focuses
    on human and nursing paradigm (Fawcett, 2005).
    It asserts that a human being cannot be healed as
    an object. It argues, on the contrary, that he/she is
    part of his/her self, environment, nature, and the
    larger universe. In this theory, the environment is
    defined as comfortable, beautiful, and peaceful
    (Lukaose, 2011; Watson, 2009; Watson, 2007)
    and that caring is the moral ideal that entails
    mind-body-soul engagement with one another.
    Nursing is categorized as a humanitarian science
    and characterized as a profession that performs
    personal, scientific, ethical, and aesthetical
    practice. Watson’s theory of Human Caring aims
    to ensure a balance and harmony between health
    and illness experiences of a person. Watson states
    that in a holistic approach to caring for a human,
    there are mind-body-spirit sub-dimensions, all of
    which reflect the whole as the whole is different
    from her/his sub-dimensions (Jesse, 2006;
    Fawcett, 2005; Cara, 2003). Therefore, applying
    Watson’s Theory of Human Caring to the nursing
    care of infertile woman, in this case study, found
    to be a fitting approach for the following reasons:
    1) Theory of Human Caring is people-oriented
    that accepts the peculiar dimensions of human
    integrity without compromising its mind-bodyspirit (Jesse, 2006; Fawcett, 2005; Watson &
    Foster, 2003; Rafael, 2000).
    2) The theory signifies that love is the most
    important healing source in nursing care
    (Watson, 2012).
    Page 26
    3) The theory defines nursing as the process of
    human-to-human caring (Fawcett, 2005) which
    consists of four basic concepts: healing
    relationship, the caring moment, and awareness
    of healing.
    4) The ten carative factors inherent in the theory
    and the well delineated caritas process (Table 1)
    provide lucid guide to clinical implementation of
    the theory. Based on the above characteristics of
    the theory, the case study design was chosen as a
    method of study. Case studies are in-depth
    investigation of a single entity or a small number
    of entities (Polit & Beck, 2008) which may be an
    individual, family, group, or other social units.
    The case study approach is particularly valuable
    for health science research to test and further
    develop theories, evaluate programs, and develop
    interventions. Case studies are empirical methods
    to demonstrate how a theory may be applied to
    practice (Baxter & Jack, 2008). Consisted with
    the method of single case study, the first author, a
    clinician and a nurse-investigator, developed a
    practice protocol based on Watson’ Theory of
    Human Caring, to care for an infertile woman
    who has had unsuccessful IVF treatment.
    Case Study
    Case Study Objectives
    1. Explore theory-based approaches to the
    holistic care of women with unsuccessful IVF
    treatment that can assist health care
    professionals in this specialty to provide
    effective nursing care.
    2. To ascertain the effectiveness of Watson’s
    theory of Human Caring in assisting women to
    cope with unsuccessful IVF
    treatments in
    traditional cultures where women’s infertility is
    equated with dishonor and shame.
    Participant selection and ethical
    Initially an approval for this single-case case
    study was obtained from the institutional review
    board of the medical center that operated the
    IVP clinic in a city located in the Southern part
    of Turkey. The participant for this study was,
    then, randomly selected from the group of
    individuals receiving care at the clinic. The
    participant was first asked verbally if she would
    International Journal of Caring Sciences
    January-April 2015 Volume 8 Issue 1
    be willing to participate in the study. When the
    response was affirmative, a written consent was
    confidentiality and described the specific nature
    of the case method, and particularly that it was a
    Page 27
    nursing study. It also stated that the
    participation was voluntary and that she could
    withdraw from the study anytime and that the
    withdrawal would have no impact, what-soever, on the care she was receiving.
    Table 1. Ten carative factors and caritas processes
    Carative factors
    Humanistic –altruistic system
    Caritas processes
    Practicing loving-kindness/compassion and equanimity for self/other.
    of values.
    Enabling faith-hope
    Being authentically present; enabling belief system and subjective
    world of self/other
    Cultivation of sensitivity to
    Cultivating own spiritual practices; beyond ego-self to authentic
    self and others
    transpersonal presence
    Helping-trusting, human care
    Sustaining a loving, trusting and caring relationship.
    Expression of positive and
    Allowing for expression of feelings; authentically listening and
    negative feelings
    “holding another person’s story for them”
    Creative problem-solving
    Creatively solution seeking through caring process, full use of self;
    caring process
    all ways of knowing/doing/being; engage in artistry of human caringhealing practices and modalities
    Transpersonal teaching-
    Authentic teaching-learning within context of caring relationship;
    stay within other’s frame of reference; shift toward a health-healingwellness coaching model
    Supportive, protective, and/or
    Creating healing environment at all levels; physical, nonphysical,
    corrective mental, social,
    subtle environment of energy and consciousness, wholeness, beauty,
    spiritual environment.
    dignity and peace are potentiated.
    Human needs assistance
    Reverentially and respectfully assisting with basic needs, holding an
    intentional, caring consciousness of touching the embodied spirit of
    another as sacred practice, working with life force/life energy/life
    mystery of another.
    Opening and attending to spiritual, mysterious, unknown and
    Spiritual forces
    existential dimensions of all the vicissitudes of life change; “allowing
    for miracle.” All of this is presupposed by a knowledge base and
    clinical competence.
    International Journal of Caring Sciences
    January-April 2015 Volume 8 Issue 1
    Page 28
    (Watson, 2012)
    Caring Moments/ Occasions
    Clinical Caritas Processes
    Face-to-face interview before
    and after the pregnancy test

    Expression of positive and negative feelings
    Human needs assistance
    Existential-phenomenological-Spiritual forces
    Telephone interview upon a
    failed treatment

    Humanistic –altruistic system of values.
    Cultivation of sensitivity to self and others
    Helping-trusting, human care relationship

    Expression of positive and negative feelings
    Creative problem-solving caring process
    Supportive, protective, and/or corrective mental, social, spiritual
    Transpersonal teaching-learning.

    Humanistic –altruistic system of values.
    Enabling faith-hope
    Cultivation of sensitivity to self and others
    Telephone interview upon a
    failed treatment
    Face-to-face interview upon a
    failed treatment
    International Journal of Caring Sciences
    January-April 2015 Volume 8 Issue 1
    A separate written consent to audiotape
    interviews was also obtained. Confidentiality and
    anonymity, which are a matter of great concern
    for individuals receiving infertility treatments,
    were maintained throughout the interviews and in
    transcriptions by using code names.
    The interviews were audiotaped, then, transcribed
    verbatim in Turkish language. Subsequently,
    transcriptions were translated from Turkish to
    English. The final version of the English
    translation was re-reviewed and refined by the
    first two investigators. Finally, translation was
    reviewed and further edited by the third author,
    bilingual nurse-researcher proficient in both
    Turkish and English.
    Implementation of the Case Study
    Mrs. E. Y, is a 23-year-old, junior high school
    graduate and housewife who lives in the center of
    an urban city. Mrs. E.Y is Muslim and she
    introduces herself as a faithful person to her
    religion and beliefs. Her husband lives in a
    different city away from the family due to work.
    Mrs. E.Y has been married for three years.
    She indicated that her in-laws expected
    grandchildren by now, and blamed her for not
    having had any children. In Turkey, in order for a
    woman to earn familial respect and social status,
    she must give birth. If a woman does not become
    pregnant, she is to blame first and soon becomes
    stigmatized as “barren”. Mrs. E. Y. and her
    husband, both interested in having several
    children, have been trying to conceive for the last
    two years. After two years of no pregnancy they
    began the IVF treatment. As part of IVF
    treatments, four oocytes were obtained via the
    Oosit Pick Up (OPU) operation. To their delight,
    one of the three alive embryos, resulted in
    successful fertilization. The fertilized embryo
    was then transferred to Mrs. E.Y, the other two
    were frozen per the couple’s wish. However,
    even though the fertilization process was
    successful the pregnancy did not seem to occur.
    Ms. E. Y. and her husband were was asked to
    come to the clinic to receive a pregnancy test
    and, based on the results, consider options.
    Receiving the results of the pregnancy test,
    positive or negative, is one of the most critical
    moments for women who have received IVF
    treatments. Hence, both the physicians and nurses
    Page 29
    are encouraged to be present at the time the test
    results are presented.
    Consistent with the plan previously approved,
    Watson’s Theory of Human Caring was initiated
    to the care of Mrs. E.Y. which included four
    interviews/interactions. The first interview was to
    be conducted on the same day, in two parts: a
    brief interview/interaction before, and the second,
    after the result of the pregnancy test was
    revealed. Both of these initial interviews were
    conducted face-to-face at the clinic. The third
    and the fourth interviews were conducted by
    telephone, as Mrs. E.Y wished not to come to the
    clinic. The interviews lasted from 45 to 90
    minutes depending on how much the participant
    wished to share. Figure 1 summarizes the major
    steps taken in the application of theory to the care
    of Mrs. E.Y.
    Caring and Healing Process
    First Interview/Interaction
    I have known Ms. E. Y. since the beginning of
    her IVF treatment process. During this period we
    developed a trusting and caring relationship as
    she shared her feelings, fears, and concerns with
    me [CCP#4]. This sustained relationship made
    me perceive her not as an IVF patient but as a
    person with hopes and aspirations for a family
    life. As the couple walked in for the pregnancy
    test, I welcomed Mrs. E.Y. and her husband in
    the role of IVF nurse implementing Watson
    Theory of Human Caring.
    Nurse: Welcome Mrs. E.Y. and Mr. Ö.Y.
    Mrs. E.Y and Mr. Ö.Y: Thank you, Nurse Yeter
    (We looked at each other with a smile. From that
    the caring process started.)
    Nurse: How do you feel since our last meeting? I
    recall you had back pains: do you still have
    them? I gave you some recommendations. Were
    you able to practice those? Were they helpful?
    [CCP#6, CCP#7].
    Mrs. E.Y: Before I talked to you, I had thought I
    was going to have a miscarriage and I was so
    scared. The recommendations you gave me made
    me feel so comfortable. I felt less scared. I was
    doing what I could.
    Nurse: You know that you will have pregnancy
    test today. If you want, we can have a talk while
    International Journal of Caring Sciences
    January-April 2015 Volume 8 Issue 1
    we are waiting. I realize this is an important time
    for you two. (Mrs. E.Y. knew that I was there for
    her and would care for her at every stage of the
    treatment. I could tell that now she considered me
    as her own nurse) [CCP#4]. Her movements and
    gaze felt like she was nervous. I asked her talk to
    me about how she felt while we were waiting for
    the result of the pregnancy test [CCP#3, CCP#5,
    Mrs. E.Y: Okay… I would be glad… If I don’t
    talk to you, I will get really tense waiting for the
    Caring and Healing Process
    Observing her tense state, I invited Mrs. E.Y. to a
    room that was designed for private talks with IVF
    patients. According to Watson’s Theory of
    Human Caring, the environment of the patient
    should be organized and decorated in physically,
    mentally, spiritually comfortable, and peaceful
    way (Lukose, 2011; Watson, 2008). Consistent
    with the theory, the rooms used for this purpose
    had been decorated as a healing environment. A
    sign “An Interview in progress: Do Not Disturb”
    was hung on the door. The room was small,
    quiet, warmly-decorated, like a family room.
    Tissue paper box and water were kept handy
    inside the room. I sat close to Mrs. E.Y. [CCP#8]
    to meet her needs for human assistance at a
    critical time. [CCP#9]).
    Nurse: All right E., would you like to share with
    me how you feel right now? [CCP#5, CCP#10].
    Mrs. E.Y: I’m having complicated feelings right
    now. I’m so excited and nervous. I can’t keep
    myself from wondering whether I’m pregnant or
    not– all the time.
    Nurse: (I held her hands): I understand! I share
    your feelings. I have been along with you since
    the beginning of your IVF treatments. We went
    through the process together. I know that you’ve
    done your best so as to have a successful
    outcome. Now we need to think positive. I will
    always be with you, and near you. [CCP#2,
    Mrs. E.Y Yes, you are right… When our
    previous doctor told us that we would never be
    able to have kids, our whole world came crashing
    down around us. However, we never lost hope.
    Thank God! Actually, having received this
    treatment is like a miracle for us.
    Page 30
    Nurse: You thing reaching to this stage of IVF
    treatment as a miracle? [CCP#10]
    Mrs. E.Y: Yes, because when our previous
    doctor had told us we would never be able to
    have kids, my husband’s hopes were dashed. He
    did not want to see any hospitals.
    But I never lost hope. We came here and met
    you; you have always been there for us and
    supported us, until now everything worked out
    Caring and Healing Process
    In this particular IVF clinic the results of the
    pregnancy tests are presented by doctors. I talked
    to the couple’s doctor and told him wished to be
    in the room when the result of the test is
    presented [CCP#3.)
    This was going to be a difficult experience for
    me. To prepare myself for the possible negative
    results, I went to the bathroom, washed my hands
    and face. After a few deep breathes, I infused
    myself into being stronger. [CCP#1, CCP#3] to
    better assist Mrs. E.Y. in receiving the test
    results. Mrs. E.Y. had told me that she wanted to
    hold my hands while she received the news.
    Three of us walked to the room in unison
    [CCP#4] greeting the physician. Then, her
    physician announced the pregnancy test was
    negative. Mrs. E. Y. started to cry. She held my
    hands and looked into my eyes and asked as if to
    hear differently.
    Mrs. E.Y: “I’m not pregnant?”
    At this emotional moment, I and Mrs. E. Y were
    feeling exactly the same. I could not prevent
    myself from crying too. I continued to hold her
    hands tightly looking into her eyes. Witnessing
    her profound disappointment to the failed
    pregnancy was heart breaking [CCP#1].
    Mrs. E.Y: I want to go home and be alone as
    soon as possible. I feel terrible now…(crying).
    The couple stood up with a definite intention to
    leave the room, and then perhaps the clinic. I
    walked them to the door. I respected their
    feelings sharing their silence. Before they left, I
    told them that I would like to continue our
    Nurse: I can only imagine how you feel. I will
    always be with you, whenever you need to talk
    please contact me. May I also call you?
    International Journal of Caring Sciences
    January-April 2015 Volume 8 Issue 1
    Mrs. E. Y. No response and a swift exit.
    Caring and Healing Process
    I began to plan as to, how can I help Mrs. E.Y.
    recover from her disappointment. How can I help
    her gain the mind-body-soul harmony [CCP#9]
    to make her hope and believe again. [CCP#2,
    Second Interview (by Phone): I called Mrs. E.Y.
    two days later.
    Nurse: Hello Mrs. E.Y. How do you feel today?
    Mrs. E.Y: (She sounded tired and sad). I’m all
    right… there is nothing to do… (she stopped
    Nurse: I can only imagine how you must have
    been feeling during these days. Do you wish to
    share your feelings with me [CCP#5]?
    Mrs. E.Y: I feel horrible now… I need to be
    alone a little more.
    Nurse: I understand, Mrs. E.Y., as you wish…
    You know that you can call me whenever you
    want. Take care [CCP#3].
    Caring and Healing Process
    This brief interaction showed to me Mrs. E.Y.
    was still experiencing a sense of profound loss
    even though there were opportunities to try again.
    I realized her disappointment with the failed
    pregnancy was still fresh and she needed to be
    alone to deal with it. It was also evident to me
    that our brief interactions were insufficient to
    help her cope with her loss. However, I needed to
    respect her wishes to be left alone with a caring
    and healing consciousness. The immediate
    challenge was to help Mrs. E.Y. to pull herself
    together and gain hope again. Because regaining
    the sense of hope was the key for her to start retreatment. I searched to find an approach that
    would reflect a caring relationship and encourage
    her find a meaning out of this experience
    I also knew that my refined approach should
    reflect love and greater compassion. I came to a
    conclusion that, as her nurse, I needed to be by
    her side more frequently and show more
    compassion in our interactions.
    Third Interview (by phone):
    Two days passed by but Mrs. E.Y. had not called.
    Due to the fact that Mrs. E.Y. didn’t feel ready to
    Page 31
    come to the clinic and preferred to stay alone, I
    decided to call her and conduct the third
    interview on the phone.
    Nurse: Hello, Mrs. E.Y., how do you feel today?
    Mrs. E.Y: I feel a little better! (Her voice
    sounded stronger compared to our previous
    phone conversation)
    Nurse: If you are able talk comfortably and have
    time I would like you share with me how have
    you been
    feeling [CCP#5]? Would it be
    OK to talk on the phone, would you rather come
    to the clinic?
    Caring and Healing Process
    In Turkey, most of the couples that start IVF
    treatment keep it as a secret. Thus, the IVF nurses
    pay strict attention to the matters like the
    availability of patients, and when to call them
    Mrs. E.Y: We can talk now. Not being able to
    become pregnant upset me so much. The test
    result shook me in my core. I was deeply affected
    by it. Everything was working out all right. Since
    everything seemed positive, facing up such a
    result was quite difficult for me. But now I feel a
    bit better.
    Nurse: The reason I called you today is to tell
    you that I wish to be by you as your nurse and
    tell you that you are not alone. I am happy to hear
    about your feelings. Also, going through
    something like this alone is difficult. Is there
    anyone supporting you? Are your parents and
    family members helping you? Do you feel
    comfortable being around them [CCP#4]?
    Mrs. E.Y: My husband has always been beside
    me. He has been stronger than me. Thanks to my
    neighbors, I have never been alone. Yet the first
    day was a nightmare. Thank God, I have gotten
    over it. I need a little more time to pull myself
    Nurse: I agree! It is helpful that you get support
    from your family and the people around you. It
    will make it easier for you to overcome this
    difficult period.
    Mrs. E.Y: Yes, you’re right. As you know, our
    families live in different cities. They are inviting
    us over. They think that if we stay with them
    during this period, it will make us overcome this
    disappointment more easily.
    International Journal of Caring Sciences
    January-April 2015 Volume 8 Issue 1
    Nurse: What do you think about visiting them?
    Mrs. E.Y: In fact, neither I nor my husband,
    wish to accept the invitations because if we go
    there our relatives will be asking thousand
    questions. Why didn’t you have a baby? Which
    one of you has the problem? Why don’t you try
    the treatments elsewhere?
    Nurse: How do you feel about yourself being in
    such an environment? How do you plan on
    responding to their questions?
    Mrs. E.Y: I don’t feel like I can answer these
    questions. My mother-in-law will be asking too
    many questions. She will be acting like I am the
    one to blame for everything… She will try to
    accuse me by saying things like I didn’t take care
    of myself and rest well-enough after the embryo
    transfer. I know I would remain silent regarding
    what she says and keep everything bottled up
    inside of me; this makes me angry and nervous.
    The in-laws make me and my husband drink
    herbal tea so that we could have children.
    Unfortunately, no matter where we go, our not
    having children comes back to haunt us.
    Nurse: I understand how you feel. It is unfair to
    be blamed for something you have no control
    over. However, it looks like you would be going
    through difficulties times with the in-laws. We
    need a plan to cope with their blaming.
    Page 32
    Nurse: If talking is putting you at ease, you can
    share how you feel with the people that you trust
    and feel comfortable with. [CCP #7]
    Mrs. E.Y: I poured myself into cleaning these
    days; I’ve been passing time by cleaning the
    house. And I’ve been praying to God. Everything
    was working out all right in our treatment… Why
    didn’t it happen?… (She started crying)
    Nurse: I understand how you feel! It must be so
    difficult for you to realize the treatment did not
    Mrs. E. Y.: A short pause, then suddenly! This is
    not rebellion against God… I always thank God
    for what we have… However, there are so many
    questions in my mind.
    Nurse: Praying could be good for you
    [CCP#10]. You can ask me the same questions
    you have on your mind [CCP#6; CCP#7]. In
    fact, when you feel better, or feel like talking
    with me, why not come up to the clinic and we
    can talk about your feelings [CCP#7] face-toface.
    Mrs. E.Y: Okay, I do want to sit and talk to you
    in person.
    Nurse: O! Great!. I would be so happy to speak
    with you, as well. If it’s okay with you, we can
    meet in a few days. Is that OK?
    Mrs. E.Y: What is worse when we visit our
    families is that all of our relatives have kids… It
    breaks my heart to see my husband playing with
    their kids and looking at them wistfully…
    Mrs. E.Y: Yes! In a few days.
    Nurse: O! Yes, that must be so hard on you. But
    les us think, what do you feel comfortable doing
    at this stage? We can plan something together.
    Nurse: You can tell them that, like “I love to see
    but I am not quite ready”. I am sure they will
    respect your wishes. I realize it may be difficult
    to come out and say it but can you give it a try?
    In this particular clinic, pregnant women whose
    pregnancy occurred via IVF method are
    appointments of the women, whose treatment
    results are negative, are arranged in such an order
    that they would not encounter the other pregnant
    women. [CCP#1, CCP#8]. Within her consent,
    an appointment was arranged for Mrs. E.Y. to
    come on a day, at an hour, when the clinic had no
    other appointments.
    Mrs. E. Y.: Silence!
    4th Interview: Face-to-face at the clinic
    Nurse: Now, let us talk about you. Could you tell
    me what you are doing to relieve your stress?
    Mrs. E.Y. entered the meeting room with a smile
    on her face. I smiled back sitting on a couch next
    to her, looking at her with sympathy and love.
    Mrs. E.Y: Opening up to you, and my neighbors,
    sets my mind at ease.
    Nurse: Thank you for coming here. (I held her
    hands). Welcome!
    Mrs. E.Y: I don’t want to visit my family for a
    long time.
    Nurse: Goodbye and lots of love and hugs.
    Caring and Healing Process
    International Journal of Caring Sciences
    January-April 2015 Volume 8 Issue 1
    Mrs. E.Y: Thank you also. Talking to you is
    good for me. It makes me feel better.
    Then, I asked her how she was feelings since we
    last talked. I asked how she dealt with the feeling
    she had been experiencing [CCP#6] with family
    and friends. She reiterated the discomfort she felt
    being with the in-laws, relatives who had
    children. Then we talked about various methods
    of problem solving as far as her emotional status
    Nurse: You have told me that there were some
    questions you wanted to ask me. If you wish, we
    can talk about those now [CCP#6]
    Mrs. E.Y: After our conversation I realized that I
    was making those concerns up in my own mind
    and exaggerating them. I noticed that I was
    making an issue of even the smallest things.
    Nurse: Do you wish to speak more about these
    Mrs. E.Y: I had a great disappointment when I
    vaccinations, drugs, procedures, and the
    prolonged period of treatment tired me. But worst
    of all was waiting for the pregnancy test result.
    Then I thought to myself, what if none of the
    embryos took. The thought of having a living
    creature in me after the embryo transfer made me
    so happy. Right now, I think that even that
    experience was good for me. It happened once,
    can happen again. I’ve never lost my hope.
    Nurse: You and I went through the IVF
    treatment process together. During this period, I
    have also experienced emotions like you did. We
    got excited, happy, sad, and together gained hope
    again. So, I understand how your emotions kept
    shifting. Do you want to talk about what you
    want to do from here on? [CCP#2, CCP#8]
    Mrs. E.Y: I want to have a rest for a few months
    and recover. And then, as you also know, I have
    more frozen embryos and I am hoping to restart
    the treatment. Thank you so much for all the help
    and support you gave me. You were always
    beside me (She held my hand and smiled).
    Nurse: Do you think the talks we have had were
    helpful in your regaining hope? Was I able to
    support you, calm you? Is there anything else I
    could do for you now to help you feel better and
    be more optimistic about your future treatments?
    [CCP#3, CCP#5]
    Page 33
    Mrs. E.Y: You’ve stood by me during the
    treatment. You’ve never left me. I thought you
    wouldn’t wish to see me after the treatment
    failed. That the pregnancy failed and you were
    done with me. But you did not leave me. You
    were there for me at those times I needed you the
    Nurse: How did having such nursing care made
    you feel? [CCP#5]
    Mrs. E.Y: I never felt alone. It gave me peace
    having someone stand by me, who is trustworthy
    and always there for me. You have always
    approached me with your positive energy and
    smile. You always treated us as if I were special.
    Nurse: Listening, facing her.
    Mrs. E.Y: The fact that you stood by me when I
    learned I wasn’t pregnant was so supportive.
    Then you called me at home. You organized a
    special atmosphere for our meetings. These
    meetings made me fell accepted and content.
    Nurse: Well, of course! I could not have left you
    alone. The IVF treatment requires a holistic care;
    it is not a process ends with treatments or
    procedures. We know women need to be
    supported before, during and after the treatment.
    Seeing you arrive a state of feeling comfortable
    with your feelings, and come to a decision to try
    re-treatments really make me so happy.
    Caring and Healing Process
    Mrs. E.Y. recognized that her inability to become
    pregnant was not an unexpected outcome of IVF
    treatments. She returned back to her usual life. A
    few months later, she returned to the clinic to try
    another treatment cycle [CCP#2, CCP#8]. Her
    return was a start of a renewed hope for her and,
    for me, it was a new phase of nursing care based
    on human caring.
    Summary and Conclusion
    Infertile couples start the IVF treatment with hopes of a pos
    such a challenging treatment process, women
    need a sustained supportive nursing care that
    builds a helping-trusting, human care relationship
    [CCP # 4]. In this case study, it was this
    relationship that prepared the Mrs. E. Y. for the
    announcement of the treatment outcome, an
    emotional time whether the results are positive or
    negative. As we saw during the meeting, when
    Mrs. E. Y. was notified of the failed pregnancy,
    she immediately turned to the nurse, not to any
    International Journal of Caring Sciences
    January-April 2015 Volume 8 Issue 1
    other in the room, to repeat what she just heard,
    “I am not pregnant?” Further, in trying to process
    the information and find ways to cope with her
    disappointment, she continued to interact with
    her nurse only, feeling comfortable in showing
    her profound disappointment with the results of
    the treatment [CCP #5], and her inner struggle
    with the way the in-laws and relatives viewed
    her. This case study also showed that throughout
    their interactions, the nurse was authentically
    present with Mrs. E. Y, facing her, making eyecontact, holding hands, even her eyes
    overflowing with tears, when the results were
    announced. Yet the nurse, using her professional
    knowledge, was still able to assist Mrs. E. Y. to
    continue to have hope and faith in the treatments
    [CCP #2]. Moreover, when Mrs. E. Y, became
    withdrawn and refused to come to the clinic for
    interviews, the nurse sustained the relationship,
    via telephone, becoming a safe sounding board to
    Mrs. E. Y. allowing Mrs. E. Y. to talk about
    family expectations, her feelings of despair,
    hopelessness and uncertainty [CCP #5]. It is
    through this sustained interaction, the nurse was
    able to move Mrs. E. Y. from hopelessness
    towards creative problem solving [CCP #6].
    While Mrs. E. Y was struggling with the decision
    whether or not to seek another treatment, the
    nurse was reverential and respectful of her
    feelings, coaching Mrs. Y. E. gently toward a
    health, healing, and wellness state [CCP #7] on
    her own time [CCP # 9]. At the end of this
    sustained caring interaction the nurse was able to
    assist Mrs. E. Y to arrive a decision to retry the
    treatment. The nurse was effective in helping
    Mrs. E.Y to arrive a decision to retry treatments
    because Mrs. E.Y perceived her nurse not only as
    a caring professional but also the one with
    professional knowledge, that the IVF treatments
    can be successful, that she should keep hope and
    give treatments another chance.
    Page 34
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